Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Quick Tip for Families in Intensive Care: My Husband hasn’t had a Swallowing Assessment for 2 Weeks; Can He Still have the Tracheostomy Removed?

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, today’s tip is basically a sequel from yesterday’s video where I was answering a question from one of our members. We have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. You can click on the membership link there and you can get access to our membership for families of critically ill patients there.

I want to answer another question from one of our members.  So yesterday, our member was asking, “What should be done for home care with tracheostomy?” I explained in my video yesterday that home care with tracheostomy can only be done with a service like Intensive Care at Home where 24/7 critical care nurses are provided in a home care setting to look after someone with a tracheostomy. Anything less than that would be futile. People have died with anything less than 24-hour intensive care or critical care nurses for someone at home on a tracheostomy. But you can check out yesterday’s video for that.

So, today’s question is from our member.

“Hi, Patrik and team,

My husband is tolerating the 21% oxygen with the tracheostomy well since yesterday to today. The speech therapist has not done a swallowing test in two weeks now. I requested a swallowing test today and the decannulation of the tracheostomy, if possible. He’s still waiting to see the speech pathologist. They seem to be dragging their feet in that direction. They tell us, we are about ready for discharge, but the home products are still being ordered. He does well on the Passy-Muir speaking valve and I would try the bolus method for the feeds today. I’m getting the practice of giving him his medications with a syringe.”

In yesterday’s video, I also talked about that one of the dieticians told our member that her husband can’t have bolus feeds via the nasogastric tube, which is nonsense. Of course, someone can have bolus feeds via the nasogastric tube as well.

Anyway, here is my response.

“Hi. I hope you’re really well.

Thank you for your email and update about your husband.

I’m really glad to know that your husband has completed 24 hours on 21% oxygen with the tracheostomy.” 21% of oxygen is room air. So, the air that you and I are breathing is 21% of oxygen.

“If he has less respiratory tract secretions, has normal blood gas results, maintains his oxygen saturation above 94% or oxygen saturation with the pulse oximeter, and has a good chest x-ray, and normal vital signs, the doctor might assess your husband and may plan for him to have the tracheostomy removed and be decannulated.

Have the doctor and the respiratory therapist assessed your husband’s breathing condition? What were their comments and plans? You can ask them about their assessment and their plans for your husband and ask if your husband is ready for decannulation or tracheostomy removal.

For successful tracheostomy removal or decannulation, your husband must have a strong cough that he can expel or spit out or can swallow his saliva or secretions. He must tolerate more than 24 hours or more off from the ventilator which your husband has completed already. Stable and good blood gas results, normal vital signs, no breathing difficulties, good oxygen saturation, and like I said, the pulse oximetry over 94% and above, present swallow reflex so he will not aspirate on his saliva secretion, sputum, et cetera. No chest infections, he must have a good chest X-ray, successfully tolerates the sleep valve for at least 12 hours or more, and it must be evaluated or assessed by the doctor, pulmonologist, respiratory therapist, speech therapist, et cetera.

Here are some links to other articles and videos that I’ve done over the years.

Number one, “When can a tracheostomy be removed?” There’s an article and a video step-by-step. Another article is, “Tracheostomy removal criteria,” “When can the tracheostomy be removed?” Another article is, “What other signs my dad in ICU can have the tracheostomy removed (decannulation)?”  Another one is about nasogastric tubes and another one is about PEG (Percutaneous Endoscopic Gastrostomy) tubes. So, I’ll put all the links below this video. I hope that explains.

For anyone watching this, never go home with a tracheostomy without 24-hour intensive care nursing. When someone has a tracheostomy, it isn’t it, a tracheostomy is an artificial airway, and it cannot be managed with family members only, cannot be managed with lay people, even nurses without emergency or intensive care experience.

When you go to our sister site intensivecareathome.com, there’s a section, Mechanical Home Ventilation Guidelines.  At the Mechanical Home Ventilation Guidelines, which are evidence-based, it says that only intensive care or critical care nurses with a minimum of two years critical care nursing experience can look after tracheostomy or ventilators at home. It’s an absolute must. Anything less than that, people can die. The goal of an ICU is to keep their beds empty, Intensive Care at Home helps to keep those beds empty.

With Intensive Care at Home currently, we are operating all around Australia in all major capital cities as well as in all regional and rural areas. We are NDIS (National Disability Insurance Scheme), DVA (Department of Veteran Affairs), TAC (Transport Accident Commission), iCare, and NIISQ (National Injury Insurance Scheme in Queensland) approved service provider and we employ hundreds of years of critical care nursing experience in the community. So, have a look at intensivecareathome.com.

Now, if you want to become part of our membership here at intensivecarehotline.com, our membership for families of critically in patients in intensive care is open. Go to intensivecarehotline.com and click on the membership link or go to intensivecaresupport.org directly. In our membership for families of critically ill patients in intensive care, you have access to me and my team, 24 hours a day, in a membership area and via email and we answer all questions, intensive care and Intensive Care at Home related.

I also offer one on one consulting advocacy for families in intensive care over the phone, via Zoom, via Skype, via WhatsApp, whichever medium works best for you. I talked to you directly. I talked to doctors and nurses directly in intensive care. I ask all the questions that you haven’t even considered asking but you must ask.

The biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care and that’s where I can help you with fast so that you can make informed decisions, get peace of mind, control, power, and influence.

I also represent you in family meetings with the intensive care team. So, if you want clinical representation in meetings with the intensive care team, please reach out. I provide that for you. Now, make sure once again, I ask all the questions that you haven’t even considered asking, but you must ask in intensive care, once again, so that you make informed decisions, get peace of mind, control, power, and influence. If I was you, I would not go into a meeting with the doctors without having your own representative and advocate there that can ask all the clinical questions.

We also offer medical record reviews in real time so that you can have a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

If you like my video, subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home, click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

Related Articles:

Quick Tip for Families in ICU: I Can’t See What Drugs My Grandma’s On in ICU, Even Though I Have Access to the Medical Records, Help! Not Knowing Whether or Not Everything that Can be Done is Being Done! Quick Tip for Families in ICU! Quick Tip for Families in Intensive Care: My Dad Has Osteomyelitis, a Pressure Sore, Sepsis, Heart Failure & Now ICU Wants to Send Him to LTAC! Can My Dad have the Tracheostomy Removed at Home? Quick Tip for Families in Intensive Care! Quick Tip for Families in Intensive Care: My 88-year-old Husband’s Been in ICU for 15 Days After a Car Accident, I Want Him to Survive, Help!